Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
It is estimated that approximately 10,000 to 15,000 people contract Legionnaires' disease in the United States each year. Legionnaires' pneumonia is not uncommon. In fact, it represents over 4% of all community-acquired pneumonias. An additional unknown number of people are infected with the Legionella bacterium but have only mild symptoms or no symptoms at all (so-called Pontiac
fever).
Outbreaks of Legionnaires' disease have received the most media attention. A recent outbreak was associated with a party at the Playboy mansion in Los Angeles where at least
four individuals contracted Legionnaires' disease. However, the disease most often occurs as single, isolated cases not associated with any identified outbreak. Outbreaks are usually recognized in the summer and early fall, but cases may occur year-round. About 5%-15% of known cases of Legionnaires' disease have been fatal.
Since the bacterium of Legionnaires' disease was identified in 1976, numerous hospital-acquired outbreaks of the disease have also been reported. These outbreaks have enabled researchers to study epidemics of legionellosis.
What are the usual symptoms of Legionnaires' disease?
Patients with Legionnaires' disease usually develop a fever, chills, and a
cough. The cough may either be dry or produce sputum. Some patients with
Legionnaires' disease also have muscle aches, headache,
tiredness, loss of
appetite, and occasionally diarrhea.
Legionnaires' disease can cause a severe pneumonia, seriously affect breathing, even lead to respiratory failure and adult respiratory distress syndrome (ARDS). In some cases, the heart rate is slower than expected for the degree of fever. There are no specific symptoms that directly identify
Legionnaires' pneumonia. Legionnaires' pneumonia presents in a manner similar to
Chlamydia pneumonia and Mycoplasma pneumonia, so-called atypical pneumonias (previously referred to as "walking pneumonia"). These are referred to as atypical because, unlike typical pneumonia (as characterized by Streptococcus pneumonia), which involves high, spiking fevers, sudden onset, cough, and purulent sputum and often chest pain and a localized infiltrate on
chest X-ray.
They can have a less virulent presentation despite very diffuse infiltrates on chest X-ray.
People with Pontiac fever experience a self-limiting influenza-like illness with fever, chills, headache, and muscle aches but, by definition, do not have pneumonia. Affected individuals generally recover in
two to five days without treatment.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. Causes of ARDS include: pneumonia, aspiration, severe blow to the chest, sepsis, severe injury with shock, drug overdose, and/or inflamed pancreas. Treatment for ARDS include extra oxygen, and/or medication.
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